SA minister 'addicted to folly'

2008-02-08 18:49

Cape Town - South Africa's health minister questioned international studies that show circumcision is effective in preventing AIDS in men.

On Thursday she reportedly said that her government was not yet ready to follow UN advice to adopt what many say is the most promising weapon against a disease that has hit SA harder than any other country.

Manto Tshabalala-Msimang, who frequently clashes with the international medical establishment, said on the sidelines of a meeting of traditional leaders that there was "not enough information" about the benefits of circumcising men and that SA was not willing to run roughshod over some communities here that traditionally frown on circumcision.

Her comments on Thursday, the latest in a string of positions Tshabalala-Msimang has taken that have earned her sharp criticism from AIDS activists, prompted one AIDS experts to call her "addicted to folly."

South Africa has an estimated 5.4 million people living with HIV -the highest in the world.

Circumcision reduces the risk of HIV

The UN says there is compelling evidence showing that circumcision can reduce the risk of contracting the virus by up to 60% and offer similar levels of protection to the elusive vaccine.

Many of the traditional leaders at Thursday's meeting portrayed the advice on circumcision as a Western attempt to force foreign values and solutions on Africans.

The World Health Organization and UNAIDS last March endorsed male circumcision as an "additional important intervention" to reduce the risk of heterosexual transmission in men.

This followed three extensive trials in South Africa, Kenya and Uganda that showed that circumcision dramatically reduced men's susceptibility to HIV infection because the cells in the foreskin of the penis are especially vulnerable to the virus.

One study projected that in the next decade, male circumcision could prevent two million AIDS infections and 300 000 deaths.

Tshabalala-Msimang said she was not convinced, given that South Africa's Xhosa ethnic communities suffer high HIV rates even though nearly all Xhosa men are circumcised.

The rates, though, are even higher amongst Zulus, for whom circumcision is taboo.

What about protecting women?

Tshabalala-Msimang also said male circumcision offers no protection for women -who bear the brunt of the HIV infections in sub-Saharan Africa.

"I can't say to people they must get circumcised when the process (of research) is ongoing," she said. "I can't go and say things to people which I can't guarantee."

Stephen Lewis, the former UNAIDS envoy for Africa and a strong critic of Tshabalala-Msimang, said the comments were typical of a minister who has espoused garlic and lemon as a remedy for AIDS and openly mistrusts antiretroviral medicines.

"She remains a minister who is addicted to folly," he said in an interview from Canada.

"There is overwhelming scientific evidence that male circumcision is one of the important ways of preventing transmission of the virus. This is proven beyond a shadow of a doubt."

Rwanda, Uganda, Zambia and Swaziland are among the African countries incorporating male circumcision as part of government AIDS prevention strategies.

The US and big donors like the Bill and Melinda Gates Foundation have said they are willing to fund such programs.

Circumcisions on the rise in Africa

Swaziland -which has one of the world's highest HIV rates with an estimated one-third of the population infected- has set up a special circumcision task force.

It is currently hosting the third visit in the space of a few months by a team of Israeli doctors training 12 Swazi doctors -a tenth of the country's total- in performing the operation.

The operation is simple by Western standards but could pose a strain on the scarce resources and facilities in cash-strapped African countries.

Swazi culture is similar to that of Zulus, who fear that circumcision will undermine their warrior traditions.

In Swaziland, the rate of circumcisions has increased from a couple per week to more than 10 per day, according to Inon Schenker, head of the Israeli mission to Swaziland.

There is a confirmed waiting list of 200 people and probably three times that number are interested in having the operation.

"I meet almost everyone who comes into the operating room," Schenker said in a telephone interview. "I ask them why did you come about 90% say this is going to allow us to be healthy."

He says that everyone who is circumcised is counselled that it does not offer complete protection against the virus; must be used in conjunction with a condom; and that men must wait until the wound has healed before having sex.

He said both the Swazi and Jewish communities were bound by strong respect for traditions.

"We are looking at the issue of male circumcision as a pure public health, medical collaboration and moving very far away from issues of religion," he said.

"But at the same time, we can talk about tradition as an important asset and not as a barrier."

- AP